| NPI | 1114203007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000034502) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH025858) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-10-24 |