| NPI | 1811195589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS40867) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH020499) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2018-03-17 |