| NPI | 1629678008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH028751) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302039443) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-27 |