| NPI | 1215222849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0012322) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202210158) |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2020-11-30 |