| NPI | 1265421515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH014670) |
| Additional Taxonomies | 1835N0905X Pharmacist Nuclear (Licence: GA RPH014670) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2015-05-29 |