| NPI | 1154543890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5928902-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 68391) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2022-07-14 |