| NPI | 1881163566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2015027479) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 117035) |
| Enumeration Date | 2018-11-25 |
| Last Update Date | 2018-11-25 |