| NPI | 1295121820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: AL 19560) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 19560) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2021-06-05 |