| NPI | 1578082236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 57609) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 019322) |
| 183500000X Pharmacist (Licence: MT 42597) | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2022-08-22 |