| NPI | 1568873966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S016489) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 0330003800) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |