| NPI | 1174808729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 34248) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 14999) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2013-03-22 |