| NPI | 1467894303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS52244) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 21708) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2014-09-17 |