| NPI | 1154669471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 0011099) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IN 26024436A) |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2021-09-22 |