| NPI | 1730764556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS E14922) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH030456) |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2021-03-12 |