| NPI | 1184799744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH022526) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 14516-040) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-08-06 |