| NPI | 1164019063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100003929) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202216109) |
| Enumeration Date | 2020-12-25 |
| Last Update Date | 2020-12-25 |