| NPI | 1518296284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00007935) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 34477) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2024-04-09 |