| NPI | 1205207495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 7759) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS13713) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2015-10-13 |