| NPI | 1386242030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 18807-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 123244) |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2020-10-14 |