| NPI | 1083942361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202006239) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 04523) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2009-11-25 |