| NPI | 1174818124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC PH 10146) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH023512) |
| 183500000X Pharmacist (Licence: VA 0202011710) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2011-06-17 |