| NPI | 1205811700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 10682) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 17035) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2021-02-06 |