| NPI | 1811366735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 17312) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC Ph100000934) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2015-09-22 |