| NPI | 1407101710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 13766) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH-027108) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2020-08-04 |