| NPI | 1154916492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0134508) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT x) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2021-03-09 |