| NPI | 1912585340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 116073) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S007897) |
| 183500000X Pharmacist (Licence: MS T-12300) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2021-03-29 |