| NPI | 1871865444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH26339) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH022864) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |