| NPI | 1508235789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 046787) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 021308) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2023-01-06 |