| NPI | 1649690850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 12602) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 15569) |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2014-04-27 |