| NPI | 1770885576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 23884) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202210480) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2013-08-15 |