| NPI | 1861095440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: RI 05600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0123366) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2023-04-24 |