| NPI | 1356469605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100000350) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 18042) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-12 |