| NPI | 1689028219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 21088) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 13237) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |