| NPI | 1801298211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S020896) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18791) |
| 183500000X Pharmacist (Licence: NC 32657) | |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2026-05-14 |