| NPI | 1982147831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP039096L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS40040) |
| Enumeration Date | 2016-11-27 |
| Last Update Date | 2016-11-27 |