| NPI | 1861515157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 010715) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 8743) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |