| NPI | 1942570239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS46590) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 51069) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2020-11-14 |