| NPI | 1629348958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL PH25203) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS36840) |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2021-05-04 |