| NPI | 1245801869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP455670) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0015301) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2021-07-06 |