| NPI | 1295081891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS49292) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2012021909) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2012-08-01 |