| NPI | 1164303673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS39479) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU6623) |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2025-09-10 |