| NPI | 1063016079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH27768) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH27767) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2020-11-30 |