| NPI | 1134722432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 41166) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2002022641) |
| 183500000X Pharmacist (Licence: KS 1-13559) | |
| 183500000X Pharmacist (Licence: LA PST.019717) | |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2020-11-18 |