| NPI | 1013500958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS60701) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: FL PS60701) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |