| NPI | 1316220502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302025685) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 26462) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2011-09-23 |