| NPI | 1922361765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA PHRE006386) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH009930) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2016-07-13 |