| NPI | 1538966718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS68370) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302417077) |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2026-05-19 |