| NPI | 1629204227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 12191) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 19733) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2020-12-31 |