| NPI | 1164810263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH2176) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 07724) |
| 183500000X Pharmacist (Licence: VA 0202009554) | |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2014-12-26 |