| NPI | 1669553350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S016023) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302030019) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-11-08 |