| NPI | 1245369487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 20106) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH022651) |
| 183500000X Pharmacist (Licence: WI 14492 - 40) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2024-06-20 |