| NPI | 1760718316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 19926) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 14767) |
| 183500000X Pharmacist (Licence: CA 38409) | |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2022-05-16 |