| NPI | 1003036864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS19132) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202006174) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |