| NPI | 1629367503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 48672) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302035614) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2012-10-24 |