| NPI | 1013288513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S018808) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 36062) |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2012-01-16 |