| NPI | 1811397003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100001792) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 22565) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2014-08-26 |