| NPI | 1497308431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 010621) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY 010621) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2023-05-03 |