| NPI | 1205245347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 54801) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00010220) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2024-11-08 |