| NPI | 1891199030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 030528) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S020982) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2022-12-20 |