| NPI | 1326648338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH031163) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS58805) |
| 183500000X Pharmacist (Licence: NY 067171-01) | |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |