| NPI | 1265784581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ s011254) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 33722) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2026-03-07 |