| NPI | 1962781633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 17611) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S017675) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2023-03-29 |