| NPI | 1114092640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 12776-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 4971) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-12-11 |