| NPI | 1164855169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 011335) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH014334) |
| 183500000X Pharmacist (Licence: AL 10572) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2013-08-13 |