| NPI | 1629352562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0026074) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA-17690) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2011-10-10 |