| NPI | 1750697892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT014230) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP441417) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2022-07-21 |