| NPI | 1861560674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PH0012202) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS0014929) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-10-19 |