| NPI | 1871895565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17932) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP043876L) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2022-12-20 |