| NPI | 1508556515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 31985) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 45640) |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-05-11 |