| NPI | 1942742606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 35200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 07913) |
| 183500000X Pharmacist (Licence: HI ph1798) | |
| Enumeration Date | 2016-11-12 |
| Last Update Date | 2016-11-12 |