| NPI | 1821285164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 23199) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH r1817) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2007-10-01 |