| NPI | 1942617121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2000173539) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps20897) |
| Enumeration Date | 2014-07-19 |
| Last Update Date | 2014-07-19 |