| NPI | 1447880968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0134951) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 22931) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2025-11-14 |