| NPI | 1073861506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 24391) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 11677) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |