| NPI | 1063163467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MO 2010031679) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: MO 2010031679) |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-01-17 |