| NPI | 1649602996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 6610) |
| Additional Taxonomies | 174400000X Specialist |
| 183500000X Pharmacist (Licence: CA 33389) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2016-10-12 |