| NPI | 1568738714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0012646) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU003519) |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2012-03-31 |