| NPI | 1376077750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH029725) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS56015) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2022-12-19 |