| NPI | 1184778664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 10090) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 36033) |
| 183500000X Pharmacist (Licence: FL PS 27719) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2024-01-26 |