| NPI | 1376644229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 24572) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH 15075) |
| 183500000X Pharmacist (Licence: MS E-04055) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |