| NPI | 1871920967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP035378L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 21715) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2021-10-27 |