| NPI | 1437676954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 64569) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 17534) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-03-18 |