| NPI | 1306267174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH025681) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 35389) |
| Enumeration Date | 2013-12-22 |
| Last Update Date | 2013-12-22 |