| NPI | 1619573524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100001045) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 26025) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |