| NPI | 1073109609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH27729) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 66278) |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2020-12-31 |