| NPI | 1447473871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 010819) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 6302) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2010-03-30 |