| NPI | 1881697480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD R-5129) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302029104) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2007-07-08 |