| NPI | 1962480376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 20890) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 16210) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2010-09-24 |