| NPI | 1952904963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202215919) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100002844) |
| 183500000X Pharmacist (Licence: OH 03337697) | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2021-07-12 |