| NPI | 1033302922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302412465) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2007025916) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2020-07-10 |