| NPI | 1730839671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 19884) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 85908) |
| 183500000X Pharmacist (Licence: TX 59542) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2022-03-24 |