| NPI | 1679934244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 16758-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 017310) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-06-16 |