| NPI | 1629429493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302032180) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MI 5302032180) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2022-05-21 |