| NPI | 1699280966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS31106) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 12877) |
| 183500000X Pharmacist (Licence: TX 44024) | |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2017-12-08 |