| NPI | 1790804581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 006811) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS26017) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |