| NPI | 1750870903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 11361) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 23206) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2018-05-03 |