| NPI | 1477321560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH20135) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R1183) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |