| NPI | 1891469433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: VA 0202219679) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: VA 0202219679) |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2024-01-24 |