| NPI | 1497355523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 013768) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15224) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |