| NPI | 1215286158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 25367) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12538) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2012-09-06 |