| NPI | 1649796368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302027576) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-08-15 |