| NPI | 1750870689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0129468) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH20336) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-05-07 |