| NPI | 1184908469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 13368) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OK 13368) |
| 333600000X Pharmacy (Licence: OK 13368) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: OK 13368) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2025-12-09 |