| NPI | 1487938205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 3178) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 23471) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2011-09-29 |