| NPI | 1073078721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AK 140545) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 60877008) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2019-02-07 |