| NPI | 1922112861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH011676) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 004007) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-07-08 |