| NPI | 1538406590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 0024272) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12567) |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2015-12-17 |