| NPI | 1053974303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 80043) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302046929) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2019-04-22 |