| NPI | 1649564923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 14690) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC PH 8906) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2011-06-04 |