| NPI | 1164854907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 12107) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 27385) |
| Enumeration Date | 2013-08-03 |
| Last Update Date | 2013-08-03 |