| NPI | 1730474289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P9887) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 98474) |
| 183500000X Pharmacist (Licence: AZ S018022) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2024-06-20 |