| NPI | 1457635567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps38361) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302021075) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2011-10-07 |