| NPI | 1669802781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 5546) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 8641) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2013-11-27 |