| NPI | 1417300310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS55061) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH029400) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2017-06-01 |