| NPI | 1700488392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH240130) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202204803) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2022-06-01 |