| NPI | 1952675050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2005001459) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 16560) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2023-01-04 |