| NPI | 1265564264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH013777) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 009717) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2011-06-03 |