| NPI | 1780312918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS64619) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH034315) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2024-11-18 |