| NPI | 1972845170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 11860) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202009849) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2013-03-26 |