| NPI | 1740560879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 13508) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22097) |
| Enumeration Date | 2011-08-20 |
| Last Update Date | 2022-12-19 |