| NPI | 1609202068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P6894) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5737114-1701) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2013-09-17 |