| NPI | 1861776775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 44551) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: TX 24340) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2024-08-26 |