| NPI | 1457347973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS32403) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PU5552) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2012-02-13 |