| NPI | 1700120672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 64282) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 57590) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2024-12-04 |