| NPI | 1881938553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 016408) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 18729) |
| 183500000X Pharmacist (Licence: FL PS29183) | |
| 183500000X Pharmacist (Licence: VA 0202009405) | |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-11-20 |