| NPI | 1962811380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS 007009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 10717) |
| 183500000X Pharmacist (Licence: TN 6674) | |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2014-08-11 |