| NPI | 1205812724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 06756) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH010744) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-07-08 |