| NPI | 1083730048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 40045) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP032599L) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |