| NPI | 1063799880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202207238) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH58515) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2022-02-01 |