| NPI | 1114203833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 023947) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 16671) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2011-10-26 |