| NPI | 1639283856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS28459) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: FL PH8741) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-02-18 |