| NPI | 1417494162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH031315) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 64368) |
| 183500000X Pharmacist (Licence: FL PS55759) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2019-10-18 |