| NPI | 1174911770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 007691) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH012275) |
| 183500000X Pharmacist (Licence: FL PS 18036) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |