| NPI | 1104125434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH2202) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 10544) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2011-03-25 |