| NPI | 1740699891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 113000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S014530) |
| 183500000X Pharmacist (Licence: IA 15882) | |
| 183500000X Pharmacist (Licence: NV 16602) | |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2014-11-13 |