| NPI | 1376881326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 8382) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC PH9255) |
| 183500000X Pharmacist (Licence: GA RPH019099) | |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2013-01-25 |