| NPI | 1023544384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S015469) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17229) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2017-05-05 |