| NPI | 1639803406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: UT 12322305-1703) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: UT 12322305-1703) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2022-07-27 |