| NPI | 1518234590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 15543) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 10065) |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2011-11-19 |