| NPI | 1225452923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 7885) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 4535) |
| 183500000X Pharmacist (Licence: GA RPH022366) | |
| Enumeration Date | 2014-02-15 |
| Last Update Date | 2014-02-15 |