| NPI | 1124300017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 23715) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IN 26011789A) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2011-09-15 |