| NPI | 1851804975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00009614) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0014259) |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2022-09-29 |