| NPI | 1376017319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 07137) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 19899) |
| Enumeration Date | 2019-01-13 |
| Last Update Date | 2022-02-18 |