| NPI | 1245821925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS61954) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: FL RPT79770) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2021-02-08 |