| NPI | 1851875058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS60141) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 37543) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2020-08-18 |