| NPI | 1649870148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2017044638) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 5667) |
| 183500000X Pharmacist (Licence: MN 122425) | |
| 183500000X Pharmacist (Licence: IA 23217) | |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |