| NPI | 1033486790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 020225479) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 15982) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |