| NPI | 1194727677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS54519) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH013819) |
| Enumeration Date | 2005-08-13 |
| Last Update Date | 2019-09-19 |