| NPI | 1497254684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0014113) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH239900) |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2022-12-23 |