| NPI | 1891140513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 24379) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 9402) |
| Enumeration Date | 2016-05-01 |
| Last Update Date | 2016-05-01 |