| NPI | 1982917092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S016659) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM 00007153) |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2010-07-17 |