| NPI | 1538178918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 10015) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS24246) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-09-01 |