| NPI | 1700485885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 17569) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 44176) |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2024-12-11 |