| NPI | 1033344924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 25664) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2020-02-06 |