| NPI | 1659473429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS56034) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM 3954) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-12-01 |