| NPI | 1558741926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS 14565) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 39170) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2020-02-12 |