| NPI | 1225770480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P9754) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0012911) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-04-08 |