| NPI | 1730459702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 61748) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS0037385) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2023-06-02 |