| NPI | 1578604104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 21067) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-10-30 |