| NPI | 1710292644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 21086) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 43110) |
| 183500000X Pharmacist (Licence: TX 49145) | |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2022-01-19 |