| NPI | 1649595612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S017702) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118279) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2014-03-27 |