| NPI | 1811211709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP040632L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI001002) |
| Enumeration Date | 2010-03-21 |
| Last Update Date | 2022-04-20 |