| NPI | 1497980502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 12592) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 15750) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2014-10-30 |