| NPI | 1578938353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 119193) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 12304) |
| Enumeration Date | 2015-12-05 |
| Last Update Date | 2015-12-05 |