| NPI | 1174927966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL PH2405) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS11104) |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2020-01-23 |