| NPI | 1518682160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302036208) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 21197060749) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2022-10-20 |