| NPI | 1275684151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH022493) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 16098) |
| 183500000X Pharmacist (Licence: SC 10373) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |