| NPI | 1811489677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 21536) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 12330) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2020-03-06 |