| NPI | 1225460991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202212474) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA PST.020234) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-08-05 |