| NPI | 1952735987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0013656) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 2079) |
| 183500000X Pharmacist (Licence: MN 120777) | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2013-08-27 |