| NPI | 1386742765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS12506) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU1754) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-08-15 |