| NPI | 1124351838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18697) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 11578) |
| Enumeration Date | 2009-09-13 |
| Last Update Date | 2022-12-24 |