| NPI | 1720293400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 35575) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15667) |
| 183500000X Pharmacist (Licence: VA 0202211331) | |
| 183500000X Pharmacist (Licence: LA 020062) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2013-03-12 |