| NPI | 1104945898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AR PD10428) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN TN10120) |
| 207Q00000X Family Medicine (Licence: TN 10120) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2021-11-29 |