| NPI | 1902489495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: RI RPH06086) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0015079) |
| 183500000X Pharmacist (Licence: KY 020685) | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2021-05-03 |