| NPI | 1205118155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH028262) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH26001) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2022-12-21 |