| NPI | 1942584701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16304) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R1776) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2019-02-23 |