| NPI | 1538050125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 75688) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID 8771052) |
| Enumeration Date | 2025-07-11 |
| Last Update Date | 2025-07-11 |