| NPI | 1003080391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 54811) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034303) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2019-04-02 |