| NPI | 1831600915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0013883) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P7676) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |