| NPI | 1821379314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 015010) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21668) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2016-11-04 |