| NPI | 1457661902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS43754) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100000745) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2012-09-23 |