| NPI | 1538379813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 17352) |
| Additional Taxonomies | 1835N0905X Pharmacist Nuclear (Licence: FL NP 87) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |