| NPI | 1336238393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD R5430) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 13526) |
| 183500000X Pharmacist (Licence: FL PS32120) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |