| NPI | 1225364771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH023533) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15360) |
| Enumeration Date | 2009-10-18 |
| Last Update Date | 2009-10-18 |