| NPI | 1285794800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 16486) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: FL PU 3528) |
| 1835N0905X Pharmacist, Nuclear (Licence: FL NS 13) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |