| NPI | 1841734894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 0020259) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18094) |
| 183500000X Pharmacist (Licence: TX 50982) | |
| Enumeration Date | 2016-12-10 |
| Last Update Date | 2016-12-10 |