| NPI | 1255749131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 35780) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 16885) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2025-12-02 |