| NPI | 1124561220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60525615) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 72810) |
| 183500000X Pharmacist (Licence: CO 20610) | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2022-04-16 |