| NPI | 1174736060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PR 002255) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS37419) |
| 183500000X Pharmacist (Licence: GA RPH015546) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |