| NPI | 1801519335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202212643) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME PR71766) |
| 183500000X Pharmacist (Licence: KY 019622) | |
| 183500000X Pharmacist (Licence: NJ 28RI03554700) | |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2023-10-20 |