| NPI | 1205454477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302043431) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301010649) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |