| NPI | 1134709058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 21430) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 83702) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-06-22 |