| NPI | 1679029524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 20824) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM 4099) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |