| NPI | 1922525724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA PTS022000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202214490) |
| 183500000X Pharmacist (Licence: DC PH100002343) | |
| 183500000X Pharmacist (Licence: MD 23972) | |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2025-02-13 |