| NPI | 1740885094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 18474) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 010245) |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2020-12-03 |