| NPI | 1457668907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH030305) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 44825) |
| Enumeration Date | 2010-09-04 |
| Last Update Date | 2019-03-03 |