| NPI | 1265572739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS37202) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 52617) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2013-01-18 |