| NPI | 1366016214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH031112) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA PHR031112) |
| 333600000X Pharmacy (Licence: GA PHRE009603) | |
| Enumeration Date | 2021-05-16 |
| Last Update Date | 2021-05-17 |