| NPI | 1083138499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH240109) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-103141) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2021-11-09 |