| NPI | 1174768022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA rph0023365) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS40911) |
| Enumeration Date | 2008-12-06 |
| Last Update Date | 2012-08-03 |