| NPI | 1164825865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA PST.011138) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA MA.001415) |
| 183500000X Pharmacist (Licence: LA PIC.011138) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2014-10-08 |