| NPI | 1861785479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21041) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 13186) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2020-10-28 |