| NPI | 1942664974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA rp033586l) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0008819) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |