| NPI | 1225863798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 14638) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302024667) |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-09-04 |