| NPI | 1023398351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 17652) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 42159) |
| 183500000X Pharmacist (Licence: TN 29324) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-08-17 |