| NPI | 1023735024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 18451) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 63375) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-21 |