| NPI | 1952692170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 012119) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 011916) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2011-04-21 |