| NPI | 1174800270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS30877) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 11899) |
| 183500000X Pharmacist (Licence: NC 19377) | |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |