| NPI | 1790007854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 16834) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439420) |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2022-12-21 |