| NPI | 1003354358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH018715) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS30547) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |