| NPI | 1114535754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH237464) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH05826) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2023-10-12 |