| NPI | 1023159001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 33263) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000003967) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2010-03-25 |