| NPI | 1164771754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202211741) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100001914) |
| 183500000X Pharmacist (Licence: FL PS54222) | |
| 183500000X Pharmacist (Licence: MD 23241) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2015-09-30 |