| NPI | 1902281108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AK 104272) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MT 25213) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2024-04-01 |