| NPI | 1699654368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps32183) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 54102) |
| Enumeration Date | 2025-08-28 |
| Last Update Date | 2025-08-28 |