| NPI | 1114697315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 22143) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 43445) |
| Enumeration Date | 2021-09-18 |
| Last Update Date | 2023-02-14 |