| NPI | 1922615921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 26759) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0005478) |
| 183500000X Pharmacist (Licence: VA 0202219076) | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2020-09-24 |