| NPI | 1659619393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19769) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH024435) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2013-01-30 |