| NPI | 1174755482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS43868) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU6458) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2009-08-20 |