| NPI | 1639879919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0016208) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP460193) |
| 183500000X Pharmacist (Licence: CO PHA.0024312) | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2026-08-11 |