| NPI | 1821459488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2015022950) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-16911) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-03-10 |