| NPI | 1831630615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH235960) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 4068) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |