| NPI | 1033404835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH026409) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21499) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2024-04-08 |