| NPI | 1376102087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 38031) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 28682) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2019-09-20 |