| NPI | 1871859629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI PH 3258) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 19978) |
| 183500000X Pharmacist (Licence: WA 00056344) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2012-04-05 |