| NPI | 1780052373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 12953) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3239) |
| Enumeration Date | 2015-09-13 |
| Last Update Date | 2015-09-13 |