| NPI | 1720361371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18545) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S019365) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2013-09-12 |