| NPI | 1568062081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6370797-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6979) |
| 183500000X Pharmacist (Licence: NV 18291) | |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |