| NPI | 1518799170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 0016629) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 126119) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2024-08-14 |