| NPI | 1427613835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202216785) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0010679) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2023-10-11 |