| NPI | 1174712715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 008527) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IN 26014524A) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2007-10-19 |