| NPI | 1649689209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND RPH5662) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 121743) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2014-08-07 |