| NPI | 1306461751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP037418L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 26247) |
| 183500000X Pharmacist (Licence: KY 020421) | |
| 183500000X Pharmacist (Licence: TN 0000042978) | |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-06-11 |