| NPI | 1922377605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS019151) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 10305) |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2011-12-23 |