| NPI | 1215188727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS37280) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0009784) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2011-04-19 |