| NPI | 1770184194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 152961-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5057) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-03 |