| NPI | 1780992644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps0014527) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL 429340) |
| 183500000X Pharmacist (Licence: GA RPH011321) | |
| 183500000X Pharmacist (Licence: TX 32803) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |