| NPI | 1679707004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 38484) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH022360) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2024-05-02 |