| NPI | 1992308720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP440399) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS55494) |
| 183500000X Pharmacist (Licence: DE A1-0004966) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2020-11-16 |