| NPI | 1245754746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: SC PH5863) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC PH5863) |
| 333600000X Pharmacy (Licence: SC PH5863) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA RPH017183) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: GA RPh017183) | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-27 |