| NPI | 1164821252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 35666) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS63515) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2026-02-27 |