| NPI | 1538605472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302043241) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH237418) |
| 183500000X Pharmacist (Licence: OK R-17258) | |
| 183500000X Pharmacist (Licence: TX 59807) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2022-07-21 |