| NPI | 1790830362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0023090) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 015501) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-10-18 |