| NPI | 1316062318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 28427) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP-032010L) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2021-02-26 |