| NPI | 1104377126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 73994) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 18113-40) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2021-12-17 |