| NPI | 1528230166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 22274) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 55608) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2010-03-11 |