| NPI | 1699162073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 76575) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S021181) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2026-06-26 |