| NPI | 1720678089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302023047) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 5302023047) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2021-01-21 |