| NPI | 1245830934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 17604) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2006031388) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |