| NPI | 1376840108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 018395) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302025399) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2019-05-23 |