| NPI | 1982062527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 57860) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00008493) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2019-09-25 |