| NPI | 1770712184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 005838) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH016407) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2013-06-05 |