| NPI | 1538450234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302029182) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 20107) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2020-03-26 |