| NPI | 1518221712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 009157) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH014037) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2012-07-02 |