| NPI | 1619450293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 9547) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 13236) |
| 183500000X Pharmacist (Licence: TX 32271) | |
| 183500000X Pharmacist (Licence: LA 13621) | |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-10-12 |