| NPI | 1306245865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ s020716) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 7993231-1702) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |