| NPI | 1811448756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 15313) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 22832) |
| Enumeration Date | 2016-10-15 |
| Last Update Date | 2023-03-21 |