| NPI | 1750659678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 12526) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 15814) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2011-12-06 |