| NPI | 1003402348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7570395-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18408) |
| Enumeration Date | 2020-12-20 |
| Last Update Date | 2020-12-20 |