| NPI | 1114249422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302038547) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 49687) |
| Enumeration Date | 2010-02-28 |
| Last Update Date | 2018-03-24 |