| NPI | 1891121703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03228299) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI PH-3048) |
| 183500000X Pharmacist (Licence: PA RP443809) | |
| 183500000X Pharmacist (Licence: AZ S020813) | |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2015-06-12 |