| NPI | 1821297268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH023031) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 29507) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2011-06-28 |