| NPI | 1851555718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 15203-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS42476) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2008-07-31 |