| NPI | 1235411786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 30591) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU 5206) |
| Enumeration Date | 2011-09-11 |
| Last Update Date | 2011-10-15 |