| NPI | 1225352339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS24134) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202011940) |
| 183500000X Pharmacist (Licence: SC 011559) | |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |