| NPI | 1376808675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 120857) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND RPh5485) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2020-04-27 |