| NPI | 1770872533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS59861) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 27064) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2021-03-28 |