| NPI | 1063798551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS 010254) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 30177) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2011-10-27 |