| NPI | 1881080513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2012029733) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 13966) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2015-04-09 |