| NPI | 1114248473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202208673) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19565) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2024-04-18 |