| NPI | 1073917290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps54352) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: FL psi28504) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2021-06-24 |