| NPI | 1376877100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0021792) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9522) |
| Enumeration Date | 2009-09-26 |
| Last Update Date | 2013-01-31 |