| NPI | 1639453913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ph16249) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps20704) |
| 183500000X Pharmacist (Licence: FL 20704) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2022-12-20 |