| NPI | 1336743640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH024146) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302036777) |
| Enumeration Date | 2020-11-27 |
| Last Update Date | 2023-08-04 |