| NPI | 1902958952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 148723-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 329033-1703) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2017-04-07 |