| NPI | 1700173721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2018029993) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0019903) |
| 183500000X Pharmacist (Licence: KS 1-106088) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2026-01-06 |