| NPI | 1972897296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI 2944) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0011783) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2011-06-03 |