| NPI | 1649365214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS48899) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302024809) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-07-27 |