| NPI | 1861735151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 11877) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 40271) |
| 183500000X Pharmacist (Licence: MO 2011017114) | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2013-04-04 |