| NPI | 1629387428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA rp449199) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21353) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2016-09-15 |