| NPI | 1336454750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 45974) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: TX 45D2206609) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 28238) | |
| 333600000X Pharmacy (Licence: TX 28238) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 28238) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2021-03-30 |