| NPI | 1184469256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: SC 60180) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 48152) |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2026-06-10 |