| NPI | 1992257257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P7648) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 122868) |
| 183500000X Pharmacist (Licence: ND RPH5870) | |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2016-11-02 |