| NPI | 1578816518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S025844) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 16482-40) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2023-01-22 |