| NPI | 1669758884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP446079) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 20634) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2016-09-15 |