| NPI | 1730588708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 113273) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 50223) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-08-15 |