| NPI | 1104229715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100001772) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202213468) |
| Enumeration Date | 2014-09-28 |
| Last Update Date | 2014-09-28 |