| NPI | 1891395950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 51432) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP444143) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |