| NPI | 1528060274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPh015584) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA RPh19518) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2020-12-09 |