| NPI | 1194134833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 67055) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03331088) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2020-12-02 |