| NPI | 1104549013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-88450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P10080) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2022-09-26 |