| NPI | 1265726038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 16972) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2024-07-10 |