| NPI | 1124311659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA-19028) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0010233) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2021-04-01 |