| NPI | 1831412048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP044598R) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 23733) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2015-06-08 |