| NPI | 1386036465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS T-12822) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 011145) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2015-02-25 |