| NPI | 1013992114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS40735) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PR 5113) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2007-07-16 |