| NPI | 1235437005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 17809) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 18135) |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2024-03-13 |