| NPI | 1073953022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 0023052) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202212223) |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2023-11-14 |