| NPI | 1629604020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 117681) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 19723) |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-03-17 |