| NPI | 1932541307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 57996) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 48201) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2018-11-02 |