| NPI | 1972106979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 15613) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 57862) |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2020-11-20 |