| NPI | 1265981013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 11234-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 58286) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-22 |