| NPI | 1245383207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS11154) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU1040) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2007-07-08 |