| NPI | 1962098483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH R0832) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH17715) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2020-12-18 |