| NPI | 1043059058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS68215) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100003271) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2026-09-08 |