| NPI | 1457633265 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS31206)  | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU6816)  | 
| Enumeration Date | 2011-09-16 | 
| Last Update Date | 2011-09-16 |