| NPI | 1841753647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: UT 5043991-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5043991-1701) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-06-11 |