| NPI | 1609463546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 20215-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 20215-40) |
| Enumeration Date | 2020-12-27 |
| Last Update Date | 2020-12-27 |