| NPI | 1891293890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA PST.022339) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 62016) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2018-01-25 |