| NPI | 1689070237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0012517) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232791) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2014-11-10 |