| NPI | 1184021545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 18211) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH025467) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |