| NPI | 1336477686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS38049) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 47160) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2011-05-13 |