| NPI | 1609387950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 24806) |
| Additional Taxonomies | 246ZA2600X Specialist/Technologist, Other, Art, Medical |
| 246Y00000X Spec/Tech, Health Info | |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2018-03-17 |