| NPI | 1457646077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 10937) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302029263) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2020-11-11 |