| NPI | 1720315013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 15862) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 48013) |
| Enumeration Date | 2009-11-08 |
| Last Update Date | 2011-09-23 |