| NPI | 1174821979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 11200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH025036) |
| 183500000X Pharmacist (Licence: TN 33515) | |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2011-03-03 |