| NPI | 1013290105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 26880) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 13854) |
| Enumeration Date | 2011-09-24 |
| Last Update Date | 2022-07-21 |