| NPI | 1447517420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS51718) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: 36024) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2021-12-07 |