| NPI | 1700228509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 11050) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 38753) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2021-01-26 |