| NPI | 1528493566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100001078) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS49846) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-09-10 |