| NPI | 1497052674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH025081) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12541) |
| 183500000X Pharmacist (Licence: NC 20589) | |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2016-07-11 |