| NPI | 1528108420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS24655) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 7253) |
| 183500000X Pharmacist (Licence: GA RPH016036) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |