| NPI | 1780928713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS47931) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 016041) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |