| NPI | 1528267549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS39993) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202206891) |
| 183500000X Pharmacist (Licence: TN 0000022114) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2012-10-26 |