| NPI | 1144591678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 15647) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 6675) |
| 183500000X Pharmacist (Licence: NC 9972) | |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-01-13 |