| NPI | 1912595216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH23486) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH03925) |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2021-01-04 |