| NPI | 1174224729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 85733) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 239401) |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2023-03-10 |