| NPI | 1013513100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP038686L) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: PA RPI005083) |
| Enumeration Date | 2020-12-05 |
| Last Update Date | 2020-12-05 |