| NPI | 1750979662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 32773) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 24340) |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2024-08-27 |