| NPI | 1205167178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 10544) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 12145) |
| Enumeration Date | 2010-01-16 |
| Last Update Date | 2010-01-16 |