| NPI | 1558495879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps28160) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA rph017201) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-08 |