| NPI | 1942400841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS40434) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: FL PS40434) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2007-07-19 |