| NPI | 1548993314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 21279-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P9957) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-10-01 |