| NPI | 1700172301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 26385) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp439436) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |