| NPI | 1528666559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 18499-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 123066) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2020-10-12 |