| NPI | 1578848024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100001031) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202210669) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2014-03-04 |