| NPI | 1487454500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202220695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 31674) |
| Enumeration Date | 2025-03-17 |
| Last Update Date | 2025-03-17 |