| NPI | 1962172585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS63236) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 38486) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2021-09-15 |