| NPI | 1649795493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S010955) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 010955) |
| 333600000X Pharmacy (Licence: S010955) | |
| Enumeration Date | 2017-08-12 |
| Last Update Date | 2017-08-12 |