| NPI | 1417419417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 66505) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5351013135) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-02-20 |