| NPI | 1699207167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000037506) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202212644) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |