| NPI | 1508159963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S020498) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP440634) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2014-08-05 |