| NPI | 1992258214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP450756) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI010710) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |