| NPI | 1174410021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023429) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-78738) |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-06-23 |