| NPI | 1538439369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS17673) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA GA12922) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-10 |