| NPI | 1245500669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA18689) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS33491) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2012-01-02 |