| NPI | 1720557077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 56317) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302038546) |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2024-08-20 |