| NPI | 1700473972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH027592) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH27601) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2020-12-22 |