| NPI | 1730771486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47358) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00008119) |
| 183500000X Pharmacist (Licence: TN 33929) | |
| 183500000X Pharmacist (Licence: MI 5302037563) | |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2021-02-04 |