| NPI | 1750950655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: LA PST.023901) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: AL 21875) |
| 333600000X Pharmacy (Licence: LA 023901) | |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-06-23 |