| NPI | 1508041385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 12072) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 16543) |
| 183500000X Pharmacist (Licence: FL PS26547) | |
| Enumeration Date | 2007-12-30 |
| Last Update Date | 2007-12-30 |