| NPI | 1558024364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 22497) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202215770) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2022-12-21 |