| NPI | 1871870154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps27887) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 14588) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2011-11-14 |