| NPI | 1962519751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 9108-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 29521) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-04-12 |