| NPI | 1396181657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH016377) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 040314) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2013-05-14 |