| NPI | 1568588515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302031881) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S017833) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2025-11-19 |