| NPI | 1306269550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL Ps51642) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA Rp041806l) |
| 183500000X Pharmacist (Licence: VI 166) | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2021-01-12 |