| NPI | 1790028462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 20843) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 25618) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2013-04-01 |