| NPI | 1093853913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 21874) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy (Licence: TN 00005328) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TN 00005328) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: TN 00005328) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: TN 00005328) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: TN 00005328) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2023-03-07 |