| NPI | 1609463785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2009032474) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: MO 2009032474) |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2020-12-23 |