| NPI | 1740880384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 56058) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS52862) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |