| NPI | 1053942300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP040017L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 42811) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2024-03-30 |