| NPI | 1114566775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 19796) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 11726) |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2024-01-26 |