| NPI | 1821401878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 12200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 23877) |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2014-06-07 |