| NPI | 1942689906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0006376) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH16879) |
| 183500000X Pharmacist (Licence: FL PS 52807) | |
| Enumeration Date | 2015-05-23 |
| Last Update Date | 2015-05-23 |