| NPI | 1639779812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 10249) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 35429) |
| 183500000X Pharmacist (Licence: NV 7951) | |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |