| NPI | 1629837083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202223157) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 44039) |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2025-09-30 |