| NPI | 1962137547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302413087) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP455526) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2022-07-19 |