| NPI | 1043596935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18284) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 5653) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-10-24 |