| NPI | 1578980025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S007279) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 053023008) |
| Enumeration Date | 2014-03-22 |
| Last Update Date | 2014-03-22 |