| NPI | 1396015665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100000747) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19350) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |