| NPI | 1639543648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP450096) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI010125) |
| Enumeration Date | 2015-11-15 |
| Last Update Date | 2015-11-15 |