| NPI | 1174908255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 211032453) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 115457) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |