| NPI | 1154797207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00009829) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 22537) |
| 183500000X Pharmacist (Licence: CO 0020876) | |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2023-05-16 |