| NPI | 1386911477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS46897) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP444092) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2013-06-08 |