| NPI | 1548877632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 27566) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202217270) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2021-12-09 |