| NPI | 1477768471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP044314L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS36449) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |