| NPI | 1467632117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS35811) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PR 4734) |
| Enumeration Date | 2007-11-10 |
| Last Update Date | 2007-11-10 |