| NPI | 1518390574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122537) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP447728) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2021-07-12 |