| NPI | 1225280415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH014737) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001933) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2017-12-07 |