| NPI | 1922545045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0011677) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH233719) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2017-01-26 |