| NPI | 1740564236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 10789) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps21747) |
| 183500000X Pharmacist (Licence: GA RPH021450) | |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2011-10-03 |