| NPI | 1710432570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH032550) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 36817) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2026-05-16 |