| NPI | 1174906192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S021072) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0007589) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |