| NPI | 1548912124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP452885) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0011490) |
| 183500000X Pharmacist (Licence: MD 27929) | |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2022-01-25 |