| NPI | 1699022442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S021746) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 38380) |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2016-08-26 |