| NPI | 1790394765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL S12081) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PSI40131) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-07-27 |