| NPI | 1811406796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202205601) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 14798) |
| 183500000X Pharmacist (Licence: CA 50075) | |
| Enumeration Date | 2017-09-23 |
| Last Update Date | 2017-09-23 |