| NPI | 1295318723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2021012909) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2021010909) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2021-05-03 |