| NPI | 1174910079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH233291) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS47470) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2023-08-11 |