| NPI | 1801122346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S012077) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 115789) |
| Enumeration Date | 2009-10-18 |
| Last Update Date | 2009-10-18 |