| NPI | 1598153801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 22823) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 9934) |
| 183500000X Pharmacist (Licence: VA 0202212836) | |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2015-01-08 |