| NPI | 1275462343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 20634) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 59305) |
| Enumeration Date | 2026-05-15 |
| Last Update Date | 2026-05-15 |