| NPI | 1457687907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 20363) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 21004) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2022-12-18 |