| NPI | 1184480717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR72466) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH PHCY-01671) |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2025-08-12 |