| NPI | 1053614180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19817) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 034489) |
| Enumeration Date | 2010-12-11 |
| Last Update Date | 2010-12-11 |