| NPI | 1558535310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AR PD09279) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 14334) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2008-04-14 |