| NPI | 1164604583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM 00007972) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP033609L) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2024-06-18 |