| NPI | 1366908865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 60914) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AR PD14038) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-09-16 |