| NPI | 1154709905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 48263) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15763) |
| 183500000X Pharmacist (Licence: LA pst020632) | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2026-01-13 |