| NPI | 1780767632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0039689) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH025519) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2013-01-15 |