| NPI | 1407145790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 015112) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH024223) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |