| NPI | 1740932847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 48012) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 13785) |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2022-01-20 |