| NPI | 1447877287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PS64261) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: FL PSI39991) |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2022-07-25 |