| NPI | 1093730848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 28440) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-06-21 |