| NPI | 1689981789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2010026496) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-15031) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2024-01-12 |