| NPI | 1306279906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 13489) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 10203) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2019-05-21 |