| NPI | 1275755407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302032025) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202011525) |
| 183500000X Pharmacist (Licence: MD 14037) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2025-03-31 |