| NPI | 1568005395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 64543) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202217318) |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2019-10-24 |