| NPI | 1982373817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 21995) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 291434) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2021-09-14 |