| NPI | 1902353279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S021828) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 57780) |
| Enumeration Date | 2016-09-04 |
| Last Update Date | 2016-09-04 |