| NPI | 1811612823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS61283) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy | |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2022-10-11 |