| NPI | 1982957999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2012027066) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-15150) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2012-10-16 |