| NPI | 1558423053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 9005) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 2431) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2025-09-11 |