| NPI | 1659595387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 7593) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 1342) |
| 183500000X Pharmacist (Licence: VI 178) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2017-03-03 |