| NPI | 1740080753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 20801) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 75091) |
| Enumeration Date | 2025-03-18 |
| Last Update Date | 2025-03-18 |