| NPI | 1114264900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 019455) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 012563) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |