| NPI | 1700163706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000007482) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 13679) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2011-11-04 |