| NPI | 1689031650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302036623) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS39508) |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2016-01-24 |