| NPI | 1134715667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 0015527) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH239483) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2022-12-30 |