| NPI | 1669750832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 11288) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202206306) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |