| NPI | 1679747349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 43160) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 45819) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2008-04-14 |