| NPI | 1881970150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH011119) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 14296) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2011-10-31 |