| NPI | 1376989608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000046473) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: TN 38776) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2022-09-21 |