| NPI | 1922243450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 20604) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 49424) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2008-12-12 |