| NPI | 1164710133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20166) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6542) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2011-07-12 |