| NPI | 1003115262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 31794) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 013992) |
| Enumeration Date | 2011-03-26 |
| Last Update Date | 2011-03-26 |