| NPI | 1790052975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202011488) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp038984l) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2021-09-14 |