| NPI | 1881925386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP444378) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 20799) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2014-12-09 |