| NPI | 1831517655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00008135) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0013940) |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2017-02-12 |