| NPI | 1356483069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PR 004455) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 38763) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |