| NPI | 1730847864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2023014774) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS58823) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2023-07-22 |