| NPI | 1174809024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 13373) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 20633) |
| 183500000X Pharmacist (Licence: PA RP445807) | |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2021-07-19 |