| NPI | 1336204254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PR 004175) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS31401) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-07-08 |