| NPI | 1962002865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 17075) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 62115) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-29 |