| NPI | 1801257977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH236128) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 51488) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2016-03-16 |