| NPI | 1801245600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC PH 35781) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA rph028114) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |