| NPI | 1033492491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000011880) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH009757) |
| 183500000X Pharmacist (Licence: AZ s012810) | |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2011-09-22 |