| NPI | 1578967105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 10475) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 19471) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2014-10-10 |