| NPI | 1861100604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 12513) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2001029138) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2022-11-10 |