| NPI | 1124506233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0013994) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 25006) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2018-07-31 |