| NPI | 1710976659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 40051) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202205810) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2026-01-26 |