| NPI | 1922862614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202006432) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0008863) |
| 183500000X Pharmacist (Licence: KY 019854) | |
| 183500000X Pharmacist (Licence: TN 0000042977) | |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-12 |