| NPI | 1598895237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 17065) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 39725) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2023-09-05 |