| NPI | 1063768844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 13972) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S024092) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2022-08-09 |