| NPI | 1891076154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202208484) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 19822) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2019-06-04 |