| NPI | 1831607134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 23781) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5302043797) |
| Enumeration Date | 2018-01-21 |
| Last Update Date | 2021-05-30 |