| NPI | 1417694506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P10481) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 4543) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2025-01-04 |