| NPI | 1508103128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 10003) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 013591) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2013-01-16 |