| NPI | 1306063102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 009964) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 15482) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-07-08 |