| NPI | 1194154096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 58358) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17216) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2018-07-22 |