| NPI | 1720749971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2021029270) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-103936) |
| Enumeration Date | 2022-01-09 |
| Last Update Date | 2022-01-09 |