| NPI | 1073875183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S013994) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302025361) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-06-13 |