| NPI | 1790067122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202205624) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 14138) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2011-09-12 |