| NPI | 1639056484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202223037) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: VA 0202223037) |
| Enumeration Date | 2025-08-21 |
| Last Update Date | 2025-08-21 |