| NPI | 1760040968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: DC PH100002129) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: VA 0202212304) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-06-03 |