| NPI | 1184162257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS55916) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 62048) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2019-08-27 |