| NPI | 1245840651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AK 162115) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302412711) |
| Enumeration Date | 2020-08-01 |
| Last Update Date | 2021-08-14 |