| NPI | 1376168518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 65960) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH031586) |
| Enumeration Date | 2020-06-13 |
| Last Update Date | 2023-11-07 |