| NPI | 1407458516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47271) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 3568) |
| 183500000X Pharmacist (Licence: FL ps43667) | |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2020-11-12 |