| NPI | 1790040863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 13922) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22700) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-10-03 |