| NPI | 1881028140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 013879) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS42384) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2013-08-22 |