| NPI | 1699160317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS55085) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 19365) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2025-03-26 |