| NPI | 1942638705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 042303) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 20948) |
| 183500000X Pharmacist (Licence: NE 13087) | |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2024-01-17 |