| NPI | 1013957208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA phre8707) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 17327) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2025-07-22 |