| NPI | 1104190990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH024513) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS42485) |
| 183500000X Pharmacist (Licence: TX 46840) | |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2012-02-27 |