| NPI | 1023739034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0134778) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH241003) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2024-04-26 |