| NPI | 1083048797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2013022753) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-17018) |
| 183500000X Pharmacist (Licence: CT PCT.0012817) | |
| 183500000X Pharmacist (Licence: NY 061564-1) | |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2022-12-15 |