| NPI | 1508207002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N0905X Pharmacist Nuclear (Licence: FL NP367) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS21238) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2013-07-12 |