| NPI | 1154624989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202011584) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA rph025624) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2010-12-16 |