| NPI | 1942386800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 010506) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202010780) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2022-02-07 |