| NPI | 1659657690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000036059) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007757) |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2011-10-21 |