| NPI | 1730256850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 11034) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033-0002591) |
| 183500000X Pharmacist (Licence: CT 4144) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2018-02-09 |