| NPI | 1659823607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 14865) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2013028398) |
| 183500000X Pharmacist (Licence: IA 22449) | |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |