| NPI | 1477940104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 23518) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP031566L) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2021-08-09 |