| NPI | 1578860656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 011800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21572) |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: SC 20351) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2021-11-11 |