| NPI | 1063729820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6258396-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18603) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2026-05-21 |