| NPI | 1457512212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA GA16177) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS41726) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2008-06-24 |