| NPI | 1518483171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH022706) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS40060) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2022-07-21 |