| NPI | 1053882647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 11620) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH2728) |
| Enumeration Date | 2018-12-08 |
| Last Update Date | 2018-12-08 |