| NPI | 1780914994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 11050) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302029259) |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2010-01-11 |