| NPI | 1144822107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS55216) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH031906) |
| 183500000X Pharmacist (Licence: NC 27541) | |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2020-11-13 |