| NPI | 1902921158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0037639) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 18629) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2013-03-13 |