| NPI | 1609283852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 13745) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 14051) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |