| NPI | 1194342402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 70604) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 83347) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2023-01-12 |