| NPI | 1215156716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 13782) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS28780) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-05-21 |