| NPI | 1730538612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 24111) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH034683) |
| 183500000X Pharmacist (Licence: VA 0202214497) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2024-06-30 |