| NPI | 1104435528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND RPH6178) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-62960) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2020-07-31 |