| NPI | 1942638101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA rp444064) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 49384) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2013-10-28 |