| NPI | 1497081178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 13903) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NC 14673) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2024-06-14 |