| NPI | 1124320023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 5297) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 1637) |
| Enumeration Date | 2010-11-27 |
| Last Update Date | 2010-11-27 |