| NPI | 1154953735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2019027674) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-110074) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2023-11-27 |