| NPI | 1750635298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 38097) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22473) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2018-04-23 |