| NPI | 1558571133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 08412) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps32171) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |