| NPI | 1649372186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS25626) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU5073) |
| 183500000X Pharmacist (Licence: AZ 9383) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2007-07-08 |