| NPI | 1124342787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP453345) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 6595) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2020-11-19 |