| NPI | 1629485636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 51342) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 53961) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2015-08-25 |