| NPI | 1760784748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS43380) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 14147-40) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2022-07-26 |