| NPI | 1972651115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 017197) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 009557) |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2011-03-15 |