NPI | 1912501685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5302032880) |
Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
Enumeration Date | 2020-11-24 |
Last Update Date | 2020-11-24 |