| NPI | 1659643476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 10438) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202007331) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |