| NPI | 1891052270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH023726) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 032651) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2012-04-23 |