| NPI | 1881038586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS62223) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 69894) |
| 183500000X Pharmacist (Licence: PR 6032) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2022-01-05 |