| NPI | 1053710616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 76368) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18381) |
| 183500000X Pharmacist (Licence: NM RP00007930) | |
| 183500000X Pharmacist (Licence: TX 55516) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2018-03-17 |