| NPI | 1124437009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2004020851) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-13634) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2025-10-27 |