| NPI | 1578995148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 08236) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC pha2074) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-08-05 |