| NPI | 1528488715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 17332) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 45793) |
| Enumeration Date | 2014-04-26 |
| Last Update Date | 2025-08-17 |