| NPI | 1982937280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000033487) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202208362) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2011-07-11 |