| NPI | 1619127982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202207340) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 18106) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2012-05-21 |