| NPI | 1194966952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202215621) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 23256) |
| 183500000X Pharmacist (Licence: MO 044890) | |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2017-11-27 |