| NPI | 1104420397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 57121) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA ph238079) |
| Enumeration Date | 2020-11-28 |
| Last Update Date | 2020-11-28 |